What Happens After an ACL Tear?

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Every year between 250,000 and 300,000 athletes undergo the long and arduous process of recovering from an anterior cruciate ligament (ACL) tear, according to Dallas Mavericks team physician Dr. Tarek O. Souryal.

Athletes are especially at risk for these injuries, because the ACL acts as the primary stabilizer in the knee, controlling the knee's rotational movement. The ligament can be stressed by changes of direction, such as the quick cuts that happen in soccer, basketball, football and . . . pretty much every sport, really. (See Understanding ACL Tears.)

Once an injury occurs, athletes are faced with two options: surgery or rehabilitation.

ACL surgery usually involves replacing the damaged ligament with an autograft from either a hamstring tendon from the athlete's own body; a patellar tendon from the athlete's body; or a hamstring or patellar tendon from a cadaver (yes, from a dead body). Patellar and hamstring tendon grafts are the most common.

Most doctors avoid open ACL surgery, preferring to make small incisions around the knee to replace the torn ligament.

According to Dr. Souryal, "ACL surgery is extremely technical. A millimeter difference here or there can have a huge impact on the result. The procedure is something that needs to be performed by an experienced sports orthopedist—someone who performs the surgery two or three times a week rather than two or three times a year, someone's who's familiar with the injury, its mechanism, and the demands when you return."

Once the surgery is complete, the athlete must spend several months strengthening and rehabbing the knee before returning to normal activity. (See The Athlete's Guide to the ACL.)

Surgery is usually more successful in repairing the ligament, avoiding cartilage damage and preventing the ACL from re-tearing. Many professional athletes, including Adrian Peterson and Willis McGahee, have undergone ACL surgery and returned to play at an elite level.

While intense rehabilitation alone is also an option, athletes can rarely return to their same level of play without surgery.